A warmer climate doesn’t just mean hotter days and longer summers. Direct effects of climate change, namely rising sea levels, more frequent, extreme storms and increased air pollution, can lead to major health issues — and the World Health Organization predicts that if global temperatures continue to rise, so will the associated health risks.

But which global warming–related illnesses will have the greatest impact, and who’s most at risk? Here’s what five healthcare experts had to say.

Megan Christenson, MS, MPH

Epidemiologist at the University of Wisconsin–Madison, population health sciences
Madison, Wisconsin

One of the biggest challenges with climate change-related health concerns in Wisconsin is the wide range of impacts that are involved. Heat extremes can lead to heat-related illnesses and deaths. Air quality degradation due to heat may also exacerbate problems for those with respiratory conditions such as asthma. Flooding can cause flood-related food and waterborne illnesses, injuries and drowning. Drought conditions can lead to reduced drinking water availability. Furthermore, the stress related to flood damage, drought impacts and economic losses may lead to mental health impacts.

Attributing health effects to climate change can be challenging. While some effects are fairly direct (e.g., high temperatures leading to heat illnesses), some relationships between climate change and health are indirect and more difficult to quantify. For example, climate change can influence vector-borne diseases such as Lyme disease by extending the season of transmission, but other factors such as changes in land use can also influence Lyme disease rates. Other conditions like mental health impacts can be difficult to directly attribute to climate change. Better understanding the complex relationships between climate and health impacts is a major goal of researchers and the public health community.

The health impacts of climate change are not experienced equally by populations. Some groups are more likely to be affected by climate change than others. Those most affected include low- income populations, communities of color, immigrant groups, indigenous peoples, children and pregnant women, older adults, vulnerable occupational groups, people living with disabilities and people with chronic diseases. It’s important for us to consider these populations when developing climate change adaptation strategies.

Rounds

Andrew Bryant, MPH, LICSW

Not surprisingly, the prospect of a disrupted climate has an impact on how people feel and behave. Some have called this pre-traumatic stress, and it is showing up in therapy offices more frequently. And as news continues to demonstrate the real-world impacts of climate change — not in the distant future, but now — people will be more directly affected by stress around climate change.

People react differently to climate-related stress and fear, using various coping mechanisms. Many respond by denying the consequences of what is happening or making small, personal lifestyle choices that alleviate their worries. These are common ways to cope when feeling overwhelmed, helpless or scared. They work in a limited way, but tend not to address the underlying feelings of fear, grief and anger about what is happening. Other responses I’ve seen as a psychotherapist include hopelessness, depression, anxiety, sleeplessness, a compulsive focus on climate-related news and social media, anger and rage, a sense of powerlessness or confusion, isolation and grief. Many parents and grandparents are scared for their children and grandchildren; younger adults are afraid to have kids.

These feelings are likely to increase if we as a society fail to take action. Mental health is frequently ignored or stigmatized in our society, and expression of feelings like sadness, fear and anxiety are often discouraged. But talking about our emotional responses to climate change is essential, because those feelings shape how we as individuals and communities respond to the crisis at hand.

Dr. Susan E. Pacheco, MD

It’s sobering what climate is doing to children. I’ve made my platform about climate change and health in the context of the pediatric population.

When it comes to the effects of climate change, kids are more vulnerable than anyone else, not only because they depend on us, but also because their brains and bodies are still developing. Climate change–associated environmental problems, like major weather events, extreme heat and air pollution, can affect children even in the womb.

Air pollution specifically is linked with many adverse health outcomes in children. Because of air pollution related to climate change, we’re seeing more kids with congenital heart disease, asthma, allergies, eczema and behavioral problems. There’s also data associating increased incidence of autistic spectrum disorders in children whose mothers were exposed to some air pollutants before the child was born.

We have clear evidence that climate and environment can wreak havoc on children’s developing brains. One doctor conducted a study on children who grew up in Mexico City and died of causes unrelated to climate change or air pollution. When she looked at their brains, she found evidence of inflammation, including pre-Alzheimer’s and pre-Parkinson’s tissue changes. While we have clear information that air pollution can cause these things, and that pollution can affect children’s brains even before they are born, so many people don’t know their kids’ brains are being affected. It’s alarming, and we need to do something about it.

Dr. Sharon Chinthrajah, MD

Clinical associate professor at Stanford University and director of the Clinical Translational Research Unit at the Sean N. Parker Center for Allergy & Asthma Research at Stanford University
Stanford, California

We are seeing more intense and more catastrophic wildfires raging across the U.S. In California especially, wildfires have significantly increased in frequency and duration during the drought season. With cities and towns blanketed with wildfire smoke, the pollutants pose serious threats to the health of tens of thousands of people. There are more than 70 medical and health organizations, including the American Lung Association, the American Medical Association and the American Heart Association, that recognize climate change as a health emergency.

Whether the wildfires burn in your community or miles away, the smoke may reach your area and put the people who have chronic heart or lung diseases at great risk. Wildfires, extreme heat and air pollution create poor air quality that puts everyone at risk, especially the young and the elderly. Smoke in the air contains fine particles and mixed gasses from burning forests and buildings. Exposure to these pollutants can irritate your eyes, nose, throat and lungs. Poor air quality can worsen asthma or COPD [chronic obstructive pulmonary disease] symptoms by causing chest pain or wheezing or bringing on an asthma attack. It can also lead to increased heart attacks and strokes.

Rising temperatures can contribute to shifts in flowering times and increased pollen counts, affecting millions who suffer from allergies and respiratory problems. This combined with air pollution can severely affect those with lung diseases and may lead to decreased productivity and missed days from school and work.

Dr. Rebecca Pass Philipsborn, MD

Assistant professor of pediatrics at the Emory University School of MedicineAtlanta

Continued use of polluting energy and amassing greenhouse gas emissions pose risks to the health and well-being of us all. But some groups, especially our children, who have contributed least to this problem, are especially vulnerable.

Climate change already causes harm to children. In my clinic, I see the links between heat and air pollution and asthma attacks, between increased pollen production from warmer temperatures and problematic allergies, between more powerful natural disasters, displacement and upheaval of children’s lives. I’ve seen pregnant women forced from their homes and support networks by hurricane evacuations navigating childbirth.

Globally, children experience climate impacts in scarcity of food and water, infectious exposures, and injury and losses in floods, disasters, migration and conflict.

Children are especially at risk because childhood is a period of rapid physical and psychological development. Adverse environmental exposures — like climate-related extreme heat, malnutrition and pollution—interfere with growing bodies and minds, blunting a child’s long-term developmental potential.

As just one example, extreme heat exposure while a baby is developing during pregnancy is associated with more birth defects and preterm births. Young children also rely on those around them to care for them and to shield them from danger. Climate change undermines this protective buffer of communities and caregivers. Patients and doctors alike have seen how climate change disrupts access to healthcare and threatens healthcare delivery.

Read this next

For people with irritable bowel syndrome, it’s common to hear that symptoms such as cramping, alternating diarrhea and constipation, and bloating are “all in their head.” In the case of IBS, there’s actually some truth to this.

It’s not that their symptoms don’t exist. IBS is a very real disorder, and managing its physical toll often becomes an all-consuming effort. The litany of concerns that accompany so many activities — always scouting the closest bathroom, making sure you can reach it in time, farting in public — keeps many people with IBS from having a social life.

Yet according to some experts, IBS is not solely about what’s going on in the digestive system; rather, the brain exacerbates the condition. “IBS is a disorder of brain-gut dysregulation,” explains GI psychologist Sarah Kinsinger, who is also co-chair of the psychogastroenterology section of the Rome Foundation. Accordingly, addressing the “brain” side of IBS through cognitive behavioral therapy with a trained psychologist may help decrease both the anxiety that’s often associated with the disorder and its physical symptoms.

“CBT really should be the first-line treatment for people with IBS. It’s the treatment with by far the most empirical support, and when done well, it can be curative,” says Melissa Hunt, associate director of clinical training in the psychology department at the University of Pennsylvania.

In a series of trialspublished last year, researchers in the UK compared the standard treatment for IBS (typically diet and lifestyle modifications and/or medication) with eight sessions of CBT delivered over the phone or online. Before and after the trials, participants answered questionnaires designed to measure their anxiety, depression and ability to cope with their illness. Two years after the trials, 71 percent of the phone-CBT group and 63 percent of the online-CBT group reported clinically significant changes in their IBS symptoms. Meanwhile, less than half of the standard-treatment group reported such an improvement. Those who did CBT also exhibited lower levels of anxiety and depression and higher coping ability than other participants.

In an earlier meta-analysis (a study of studies), published in 2018 in the Journal of Gastrointestinal and Liver Diseases, a different team of researchers also found that CBT appeared to reduce both psychosocial distress and the severity of IBS symptoms, with a greater effect on the physical symptoms than on the mental ones.

Explainers

The brain-gut connection

How this happens is not completely clear at this point, but it’s believed to have something to do with how the gut and brain communicate.

“IBS is thought to be a disorder of centralized pain processing,” Hunt explains. “There is miscommunication between the pain centers in the brain and the nerves in the gut. In people with IBS, pain signaling gets inappropriately amplified.” Discomfort that wouldn’t even register in the majority of people feels like being stabbed in the gut to a person with IBS. “The best way to address that is to find ways to help reduce pain signaling, and that’s with a psychologist,” Hunt says.

CBT for IBS entails learning relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, which help reduce the “volume” of the pain signals by activating the parasympathetic nervous system, i.e., the body’s “rest and digest” response. “This can also lead to increased blood flow and oxygen to the digestive system, which helps the GI tract to function in a more rhythmic way,” says Kinsinger, who is also an associate professor at Chicago’s Loyola University Medical Center.

CBT also involves thought restructuring. IBS can cause a cycle of worry: Worrying about symptoms leads to being hyperfocused on the slightest hint of any symptom, which increases anxiety, which aggravates symptoms. People with IBS also often catastrophize, meaning they assume the worst will happen (“If I have an accident at work, I’ll get fired and never get another job”), develop social anxiety and become withdrawn. CBT addresses these issues by shifting attention away from IBS symptoms and using exposure therapy to help people gradually engage in more activities outside their homes.

Additionally, using CBT, people with IBS learn to identify and change dysfunctional ways of thinking. For example, consider someone with school-aged children who asks their spouse to attend all school functions because they’re afraid of farting in a room with other parents, which would inevitably cause humiliation and might even make people think they’re disgusting A therapist might ask them how often they notice bodily noises from other people to help them realize that we’re a lot more cognizant of our own bodily functions than other people are. “In other words, we identify the catastrophic beliefs and then search for evidence supporting them or not,” Hunt says.

CBT is a skills-based, goal-oriented approach to treating mental disorders that emerged in the mid-20th century. All CBT programs share the same underlying goal of helping patients identify and modify negative or unhelpful thought patterns and behaviors. “It teaches patients techniques that they can then implement on their own.” says Kinsinger. “It can be done pretty efficiently, depending how motivated and receptive one is to learning these skills.” But over time, customized versions of CBT have been developed for specific conditions including insomnia, schizophrenia and IBS. Different versions of CBT use different techniques, such as role-playing, exposure therapy and relaxation exercises, and vary in length. On average, CBT for IBS lasts between 4 and 10 sessions in total.

Jeffrey Lackner, professor and chief of the division of behavioral medicine at the University at Buffalo, SUNY, says their program is structured like a course: “You learn a specific skill to manage your GI symptoms, process information differently or respond to stress in a less extreme way. Then you practice that skill in session before using it in the real world.” Often therapists also give patients homework to fine-tune the skills they learn. They come out of CBT with a toolbox of techniques to manage the day-to-day burden of IBS.

Some people with IBS do CBT on their own, using self-help books, online materials or apps without ever seeing a therapist. “Not many psychologists are trained to treat GI disorders specifically, so physicians don’t often have anyone to refer patients to,” Kinsinger says. The Rome Foundation trains psychologists and maintains a directory of gastrointestinal psychologists, but if someone can’t find a provider in their area, Hunt and Kinsinger recommend looking for a psychologist who’s trained in CBT and has experience treating chronic pain, panic disorders or anxiety.

Reducing sensations vs. reducing sensitivity

Not everyone is fully on board with CBT for IBS. One 2018 review study found “insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases” including IBS. A different 2018 review concluded that although psychological treatments for IBS appear to help in clinical trials, it’s unclear if they work in other settings and which treatments — such as CBT, mindfulness-based stress reduction and guided affective imagery — are most effective.

IBS is a complex problem, and some doctors prefer to integrate CBT with other treatments. But “by the time we see them,” Lackner says, “many of our patients have found that the medical treatments have not provided adequate symptom relief.”

Some IBS patients also find thetraditional approaches too hard to stick with. The most commonly prescribed treatment is a “low-FODMAP” diet, which requires giving up all dairy and legumes, plus many grains, fruits and vegetables. “Some trials show that even if the diet reduces or eliminates GI symptoms, it doesn’t improve quality of life because it’s crazy restrictive,” Lackner points out.

“With IBS, the nerve endings in the gut have become hypersensitized, and the brain magnifies those signals in the gut,” Hunt says. “The low-FODMAP diet tries to reduce the sensations, whereas CBT reduces the hypersensitivity. When you turn down the volume on the sensations, then you can eat whatever you want.”

Whether CBT helps with this brain-gut dysregulation, addresses distorted thinking and anxiety, or increases confidence in a person’s ability to manage gastrointestinal symptoms — or all of the above — it’s helped people with IBS resume parts of their life they’d put on hold.

Brittany Risher is a writer, editor and digital strategist specializing in health and lifestyle content. She's written for publications including Men's Health, Women's Health, Self and Yoga Journal.

Dig Deeper

About us

The Paper Gown, powered by Zocdoc, covers health and healthcare with a focus on patient experiences — inside and outside the exam room, before check-ups and after surgery, across all states of health. We strive to tell stories that help patients feel informed, empowered and understood. Learn more.